Leave the NCLEX questions for another day…

This morning I woke early, thinking about a question posted on the HPNA Educators Special Interest Forum. A palliative care nurse had been asked to give a short presentation on palliative care to second semester nursing students. The palliative care nurse outlined an engaging education session and then asked about writing or accessing NCLEX style questions to use at the end of the presentation. This question has been on my mind for the past few days.
Here is my response:

I would like to comment on the request behind your question about providing an engaging education session and about integrating NCLEX style questions. The request I would like to comment on is, “…to give a short presentation on palliative care.”

One of the significant challenges that palliative care is facing across North America (and globally) is in helping nursing faculty, curriculum developers, regulators, and accreditors to realize that palliative care needs to be integrated in core curriculum. It cannot and should not be allocated a short presentation, here or there.

The ideas that have been shared in the forum are wonderful. But if, in your short presentation you can inspire and engage the students, light a spark of interest and love for palliative and hospice care, help those who carry some fear to be less afraid, and help them to understand that care of the dying is the responsibility of every nurse, then you will have accomplished a great thing. And I doubt you will have time to discuss NCLEX questions!

You can also help by educating the educator – the person who asked for your presentation. They may appreciate hearing about palliative care resources for teaching their students. They may benefit from hearing about ways to help the rest of the faculty understand the need for palliative care in the core curriculum.

YES to the ELNEC resources mentioned by Toni, Megan, Polly and Dell, (including the NCLEX style questions – because educators love to hear about NCLEX style questions even more than students do!) And YES to the superb movies and clips shared by Megan, Barbara and Donna!

I would like to share the “Competencies And Recommendations for Educating Undergraduate Nursing Students Preparing Nurses to Care for the Seriously Ill and their Families” (CARES) developed by ELNEC, available here.

I never thought I would be a lover of competencies, but my goodness, they are essential!

As a co-chair for the Canadian Association of Schools of Nursing Palliative End-of-Life Interest Group, and a board member of the Canadian Hospice Palliative Care Nurses group, and an author of a few palliative care texts and companion resources, I am thinking A LOT about advocacy.

We need to support educators, as you are doing by responding with heart and soul to this request.  We also need to be intentional and teach faculty, curriculum developers, regulators, and accreditors that palliative care is not an option, but instead, it is an essential part of nursing education.

All the very best in your presentation. The students and their educator will love to hear from you, from your heart. They will remember the stories that are behind the cases that you discuss. Leave NCLEX for the longer presentation ?.

Warm regards and please let us know how it goes!

Kath Murray

(The resources I shared are US based, as HPNA is an American association.) What are your thoughts on this?
Across North America I hear students say, “I am sick of hearing that i need to know this for the NCLEX…. I know it is important, but right now, I just want to learn to nurse, not just pass an exam.”

And what are your thoughts on advocacy? What is our role? What is your role?

Love to hear from you!

Don’t go whistling past the digital graveyard!

Written by Angela Bruce, RN

Thanks to Kaylee for directing us to a blog post that reminds us how important it is to get our digital house in order.  On August 10, 2019 she provided the link to this comprehensive guide containing current advice and instructions on how to plan for your digital legacy and your assets after you die. The author of the blog states,

With hundreds of millions of social media users, the number of social media accounts of dead people may outnumber those of the living in a few decades. 

But as you consider the eternal limbo of those accounts remember this cold, hard fact: In this digital age, your loved ones will be faced with the complexities of managing your digital assets after you die.

Accessing digital devices like computers, hard drives, tablets, and phones, may be impossible if your loved ones don’t have passwords or encryption keys. Not only may they lose irreplaceable photos, important letters and documents, there are financial assets that may be forever lost.

These monetary assets go far beyond your bank account. For example, Bond Brand Loyalty estimates there are currently $16 billion dollars in unredeemed loyalty points in Canada alone, and many of those dollars will never be redeemed if the owner has died with no arrangement to transfer ownership of the points. According to a report in the Globe and Mail, by the end of 2020, the average Canadian will have accumulated $10,000 worth of digital assets, including money stored in online payment accounts, loyalty program rewards, virtual currencies and online investment or bank accounts.[1]  Keeping track of your digital presence is a sound, personal, and economic practice.

Digital assets to consider when making an inventory of  your online presence include:

Financial Access

  • Bank accounts
  • Online payment accounts (such as PayPal)
  • Online seller accounts (like Amazon™ or eBay®)
  • Brokerage accounts
  • Cryptocurrency investments


  • Email accounts
  • Social media accounts
  • Forums or chat rooms
  • Blogs or websites you own
  • Online gaming accounts

Cloud Storage

  • OneDrive; Dropbox, GoogleDrive etc
  • Digital photos, videos and music files
  • E-books or audio books

Loyalty/Rewards Programs

  • Credit card loyalty program rewards
  • Travel rewards programs (such as Air Miles)
  • Retailer loyalty programs


  • Logos, illustrations, artwork or animations you own
  • Digital copyrights, trademarks or patents[2]

Adding to the confusion, there is a wide diversity in policies for dealing with the death of platform members.  Legislation on digital death has not kept up with the rapid pace of technological advancement.  Worldwide, there is a lack of established laws and this has allowed companies to choose their own rules.  Social media platforms have a patchwork of ways for dealing with a member’s death.  Customer loyalty programs may not be transferable. Purchased digital media assets, such as iTunes or eBooks, cannot be transferred.

Three decades ago, there was no such thing as planning for your digital death. Now it is increasingly seen as a task that is essential to ease the work of our loved ones after our death, allowing access to funds to pay bills, cover other expenses, and to manage or close accounts. Think of it as advance care planning for your digital life. Tackling this chore will save many hours of stress and heartache for your loved ones and potentially save priceless memories, assets, and facets of your life from being irretrievably lost in the cold vacuum of cyberspace.

Have you had any experiences dealing with digital death? Please share your story in the comments section!

Warm regards,

Angela Bruce

Looking for more information on this subject.

Death and Digital Property: What happens to your online life when you die?

 March 29, 2015 by Kath Murray

Creating a Digital Estate

April 5, 2015 by Kath Murray


[1] https://www.theglobeandmail.com/investing/globe-wealth/article-dont-forget-about-digital-assets-in-your-estate-plan/

[2] https://www.cibc.com/en/personal-banking/advice-centre/family-finances/estate-planning-for-digital-assets.html

Voices to Lead | A Modern Application of Florence Nightingale’s Legacy

Guest Post by Angela Bruce, RN

Florence Nightingale in the Crimean War

Photo Credit: www.healinghealth.com

When I think of a single nurse’s voice, Florence Nightingale comes to mind. In the midst of the Crimean War battlefields, the “lady with a lamp” provided compassionate care to the sick and injured, murmuring words of comfort and offering a touch to frightened boys, some crying out in distress. In the squalor Florence triaged as she went, knowing that so many needed care and that few would survive to see another day. While Florence is known as the “lady with the lamp” she also used her voice to effect change. She galvanized others to lead with their voices and demand changes. Voices that said it was not acceptable that ten times as many soldiers died in the Crimean War from infectious diseases than from injuries, and that it was also not acceptable that hospital floors in England were covered in straw that was matted with urine and blood. These voices for led to the sanitary conditions and standards of care that we have today.

Today, there are still many serious issues affecting health care where voices that lead could effect change, such as:    

  • Lack of access to care for any people in need
  • Scarcity of resources, e.g., personnel, diagnostic services and so on
  • Non-essential antibiotic use in a world of increasingly resistant organisms
  • Restricted access to opioids for people experiencing pain and other severe symptoms, in response to overdose deaths and the Opioid Crisis.

I hope nurses can agree that these are urgent issues.

Voices to Lead for Palliative Care Education

Voices to lead can help ensure hospice and palliative care education for everyone

Photo Credit: https://moments.nhpco.org/news-blogs/hospice-photography

Each of the serious issues listed above directly affects the capacity of health care professionals to provide hospice, palliative and end-of-life care. In 2018 the Government of Canada’s Framework on Palliative Care in Canada Act acknowledged the need to prepare caregivers in their long term goal that stated, “… all providers have increased capacity to deliver quality (palliative) care.” Preparing primary care teams to integrate palliative care for individuals with any life-limiting illness, from early in the disease process through to and following death, in all care settings will help address the serious issues listed above. Using our voices together to integrate and strengthen palliative care education in core curriculum has the potential to prepare health care professionals to deliver palliative care by:

  • Placing the topic of death on the table as a normal part of living and a topic for discussion.
  • Encouraging information sharing, advance care planning and discussions of goals of care.
  • Supporting the intentional use of emergency departments and acute hospital admissions.
  • Supporting informed and effective prescribing of medications for symptom management (including safe prescribing of opioids).

Providing learner-centered palliative care education in the workplace, and mentoring individuals before, during and after education, may also inspire more members of the health care team to seek out additional education and become specialist palliative care providers.

With the aging population, limited resources, and the desire to provide excellent care for people with any life-limiting illness, palliative care needs to be part of core curriculum for every member of the health care team.

Just as our predecessors used their voices to lead and improve care for today, let us join our voices to lead and improve care for tomorrow. 

What are PSWs saying about the text, Integrating a Palliative Approach?

Life and Death Matters reached out to a few colleges and hospices using the text, Integrating a Palliative Approach: Essentials for Personal Support Workers, and companion resources in their teaching  and asked permission to survey students about their learning experiences in hospice and palliative care. An online survey was distributed to individuals who used the resources and were completing their practicum, had graduated or had completed a self-study program. The survey results resoundingly endorsed the text, Integrating a Palliative Approach: Essentials for Personal Support Workers, as a positive learning tool for learning to provide hospice, palliative and end-of-life care.

In the survey, students were asked to reflect on their learning experiences and indicate which statements they agreed with. These are some of the results:

  • 80% indicated “I will keep this text and continue to use this in my practice.”
  • 75% indicated  “I know how to support a person experiencing common symptoms of life-limiting illness”
  • 74% indicated “I strengthened my skills for communicating with people experiencing life-limiting illness and their family.”
  • 83% reported “I learned why self-care is important, and how to provide self-care.”

Students self-reported what they had learned from the text and companion resources. The results indicate the percentage of respondants who reported learning each topic from the text and resources.

  • 90% – How to recognize different patterns of dying
  • 88% – Ways to prepare myself for providing hospice and palliative care
  • 86% – Strategies for communicating with a person and family about difficult topics
  • 83% – How to recognize, observe, record and report when a person is experiencing a common symptom, e.g., pain.
  • 83% – The different ways people experience loss and grief, and how to provide appropriate support
  • 88% – The common changes in the last days and hours of life and how to support a dying person and family
  • 86% – How to provide self-care to maintain my personal health when working in hospice and palliative care.


This survey strongly supports teaching hospice, palliative and end-of-life care to PSW students using the text, Integrating a Palliative Approach: Essentials for Personal Support Workers, and companion workbook, podcasts and videos.

There are more results, including the interview of instructors to report. Look for that information in upcoming blog posts.